Positive airway pressure ( PAP ) is a respiratory ventilation mode used in the treatment of sleep apnea. PAP ventilation is also commonly used for critically ill patients in hospitals with respiratory failure, in newborns (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation may prevent tracheal intubation, or allow for previous extubation. Sometimes patients with neuromuscular disease use these vents as well. CPAP is an acronym for "continuous positive airway pressure", developed by Dr. George Gregory and colleagues at the neonatal intensive care unit at the University of California, San Francisco. A variety of PAP systems was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.
The main difference between BiPAP and CPAP machines is that the BiPAP machine has two pressure settings: the pressure specified for inhalation (ipap), and lower pressure for breathing (epap). Multiple settings allow patients to get more air in and out of their lungs.
Video Positive airway pressure
Medical use
The main indications for positive airway pressure are congestive heart failure and chronic obstructive pulmonary disease. There is some evidence of benefits for those with community acquired hypoxia and pneumonia.
PAP ventilation is often used for patients with type 1 or 2 acute respiratory failure. Usually a PAP ventilation will be provided for a subset of patients given oxygen through a facial mask considered insufficient or disruptive to health (see CO 2 retention). Typically, patients with PAP ventilation will be closely monitored in intensive care units, high dependency units, coronary care units or special respiratory units.
The most common conditions in which PAP ventilation is used in hospitals are congestive heart failure and acute exacerbation of obstructive airway diseases, especially exacerbations of COPD and asthma. It is not used in cases where the airway can be disrupted, or awareness is disrupted. CPAP is also used to help premature babies with breathing in NICU settings.
The masks needed to send CPAP must have an effective seal, and should be held very securely. The "nasal pillow" mask retains the seal by being inserted slightly into the nostrils and held in place by various straps around the head. Some face masks full of "floating" on the face like a kite craft, with thin and soft "curtains", ensuring fewer skin abrasions, and possibly coughing and yawning. Some people may feel wearing an uncomfortable or narrow CPAP mask: wearing glasses and bearded men may prefer a nose-pillow mask type. Inhaling positive pressure resistance (respiratory positive respiratory pressure component, or EPAP) may also be unpleasant for some patients. These factors lead to the inability to continue treatment because of patient intolerance in about 20% of cases where it begins. Some engines have pressure-relieving technology that makes sleep therapy more comfortable by reducing the pressure at the onset of breathing and returning to therapeutic pressure just before inhalation. The level of pressure relief varies according to the patient's expiratory flow, making breathing resistance to pressure more difficult. Those who suffer from anxiety disorder or claustrophobia tend not to tolerate PAP treatment. Sometimes drugs will be given to help anxiety caused by PAP ventilation.
Unlike PAPs used at home to split the tongue and pharynx, PAPs are used in hospitals to improve the lung's ability to exchange oxygen and carbon dioxide, and to reduce respiratory work (the energy released moves air in and out of the alveoli). This is because:
- During inspiration, inspirational positive air pressure, or IPAP, forces air into the lungs - so less work is required of the respiratory muscles.
- Bronchioles and alveoli are prevented from collapse at the end of expiration. If these small airways and alveoli are allowed to collapse, significant pressure is required to extend them again. This can be explained by using the Young-Laplace equation (which also explains why the most difficult part of blowing a balloon is the first breath).
- The entire area of ​​the collapsed lung is forced and left open. This process is called recruitment. Usually this collapsed lung region will have a blood flow (although it is reduced). Because these areas of the lungs are not ventilated, blood passing through these areas can not efficiently exchange oxygen and carbon dioxide. This is called venting-perfusion (or V/Q) mismatch. Recruitment reduces ventilation-perfusion mismatch.
- The amount of air remaining in the lungs at the tip of the breath is greater (this is called functional residual capacity). Therefore the chest and lungs are more expanded. From this wider break position, less work is needed to inspire. This is due to the non-linear pulmonary compliance volume curve.
Maps Positive airway pressure
Loss
The main problem with CPAP is non-compliance. Studies show that some users ignore the use of CPAP, and/or use CPAP for only a fraction of the night.
Candidates for PAP candidates are often reluctant to use this therapy, because the mask of the nose and hose to the machine looks uncomfortable and clumsy. The airflow needed for some patients can be very powerful. Some patients will experience nasal congestion while others may have rhinitis or colds. Some patients adjust to treatment within a few weeks, others struggle for longer periods, and some stop treatment entirely. However, studies show that cognitive behavioral therapy at the start of therapy dramatically improves adherence - up to 148%. While the common side effects of PAP are only disturbances, serious side effects such as eustachian tube infection, or pressure buildup behind the cochlea are very rare. Furthermore, studies have shown that PAP side-effects are rarely the reason patients stop using PAPs. There are reports of dizziness, sinus infections, bronchitis, dry eyes, irritation of dry mucous tissue, earache, and nasal congestion due to CPAP use.
PAP manufacturers often offer different models at different price ranges, and PAP masks have different sizes and shapes, so some users need to try several masks before finding matches. These different machines may be uncomfortable for all users, so choosing the right PAP model may be crucial in advancing adherence to therapy.
Beards, mustaches, or facial irregularities can prevent airtight seals. Where the skin contact mask should be free of dirt and excess chemicals such as skin oil. Shaving before mask installation may be necessary in some cases. However, this natural facial irregularity often does not impede device operation or positive airflow effects for sleep apnea patients. For many, the only problem with incomplete seals is the higher noise level near the face of the escaping air.
The CPAP mask may act as an orthodontic headgear and move the teeth and upper jaw and/or lower jaw back. These effects may increase over time and may or may not cause TMJ disorders in some patients. This face change has been dubbed "Smashed Face Syndrome".
Action mechanism
Continuous pressure device
CPAP fixed pressure
The positive positive airway pressure (CPAP) machine was initially used primarily by patients for the treatment of sleep apnea at home, but is now widely used throughout the intensive care unit as a form of ventilation. Obstructive sleep apnea occurs when the upper airway becomes narrow when the muscles relax naturally during sleep. It reduces oxygen in the blood and causes stimulation from sleep. The CPAP machine stops this phenomenon by draining compressed airflow through a tube into a nasal cushion, a nasal mask, a full-face mask, or hybrid, breaking the airway (keeping it open under air pressure) so that blocked breathing becomes possible, and/or prevent apnea and hypopnea. It is important to understand, however, that it is air pressure, and not air movement, which prevents apnea. When the engine is turned on, but before the mask is placed in the head, the airflow comes through the mask. After the mask is placed on the head, this mask is sealed to the face and air stops flowing. At this point, only the air pressure reaches the desired result. It has the added benefit of reducing or eliminating the very loud snoring that sometimes accompanies sleep apnea.
The CPAP engine blows air at a determined pressure (also called the titration pressure). The required pressure is usually determined by the sleeping doctor after reviewing a study supervised by a sleep technician during overnight studies (polysomnography) in a sleep laboratory. Pressurized pressure is the air pressure in which most (if not all) apnea and hypopnea have been prevented, and are usually measured in centimeters of water (cmH 2 O). The pressure required by most patients with sleep apnea ranges between 6 and 14 cmH 2 O. A typical CPAP machine can provide pressure between 4 and 20 cmH 2 O. More units specifically can send pressure up to 25 or 30 cmH 2 O.
CPAP treatment can be very effective in the treatment of obstructive sleep apnea. For some patients, improved sleep quality and quality of life due to CPAP care will be noted after one night is used. Often, the sleeping pairs of patients also benefit from excellent sleep quality, due to the patient's loud purring amelioration.
Given that sleep apnea is a chronic health problem that is generally not lost, ongoing care is usually necessary to maintain CPAP therapy. Based on studies on cognitive behavioral therapy (referred to above), ongoing chronic care management is the best way to help patients continue therapy by educating them about the health risks of sleep apnea and providing motivation and support.
Automatic positive airway pressure
A positive positive airway pressure device (APAP, AutoPAP, AutoCPAP) automatically titration , or a tone, the amount of pressure that is sent to the patient to the minimum required to maintain an unobstructed airway. on a breath-by-breath basis by measuring resistance in the patient's breathing, thus giving the patient the exact pressure required at a given moment and avoiding a compromise of fixed pressure.
Bi-level pressure device
"VPAP" or "BPAP" (variable positive air pressure/bilevel) provides two levels of stress: inspiratory positive air pressure (IPAP) and low expiratory positive air pressure (EPAP) to facilitate breathing. (Some people use the term BPAP to parallel APAP and CPAP terms.) Often BPAP is incorrectly referred to as "BiPAP". However, BiPAP is the name of a portable ventilator manufactured by Respironics Corporation; it is just one of many ventilators that can deliver BPAP.
- Mode
- S (Spontaneously) - In spontaneous mode the device triggers IPAP when the flow sensor detects a spontaneous inspiration effort and then cycles back to EPAP.
- T (Timed) - In timed mode, pure IPAP/EPAP cycles are triggered by the machine, at a specified level, usually expressed in breath per minute (BPM).
- S/T (Spontaneous/Timed) - Like spontaneous mode, this tool triggers IPAP in an inspirational effort. But in spontaneous/timed mode, a "reserve" rate is also established to ensure that patients still receive a minimum amount of breath per minute if they fail to breathe spontaneously.
Respiratory positive airway tool
Positive nasal nasal air pressure (Nasal EPAP) is a treatment for obstructive sleep apnea (OSA) and snoring.
Contemporary EPAP devices have two small valves that allow air to enter through every nostril, but not exhaled; the valves are retained with an adhesive tab on the outside of the nose. The mechanism of work of EPAP is not clear; it may be that resistance to nasal respiration leads to a buildup in CO 2 which in turn increases the breathing impulse, or that respiratory resistance produces a pressure that forces the upper airway to open wider.
Components
- The flow generator (PAP engine) provides airflow
- Hoses connect a flow generator (sometimes via an in-line humidifier) ​​to the interface
- The interface (full nose or facial mask, nasal cushion, or rarely lip-sealed mouthpiece) provides connection to the user's air duct
Optional features
- Humidifiers add moisture to low humidity
- Heated: a hot water chamber that can improve patient comfort by eliminating the drought of compressed air. Temperature can usually be set or turned off to act as a passive humidifier if desired. In general, a heated humidifier can be integrated into a unit or has a separate power source (ie a plug). Passive: Air is exhaled through an unheated space and depends on the ambient air temperature. It is not as effective as the heat humidifier described above, but can still improve patient comfort by eliminating the dryness of compressed air. In general, the passive humidifier is a separate unit and has no resources.
Such features generally increase the likelihood of PAP tolerance and compliance.
Care and maintenance
Like all durable medical devices, proper care is essential to functioning well, long unit life and patient comfort. The maintenance and maintenance required for a PAP engine vary with the type and conditions of use, and is usually spelled out in detailed instruction manuals specific to brands and models.
Most manufacturers recommend that end users do daily and weekly maintenance. The unit should be checked regularly to avoid damage and keep it clean. Electrical connections that are not connected properly, obsolete or fraying may cause a shock or fire hazard; The hoses and masks used can reduce the effectiveness of the unit. Most units use several types of filtration, and filters must be cleaned or replaced on a regular schedule. Sometimes HEPA filters can be purchased or modified for asthma or other allergic clients. Hose and mask accumulate peeling skin, particulate, and even can develop fungus. The humidification unit should be kept free of mold and algae. Because the unit uses large electrical power, the house must be cleaned without dyeing. For the humidification unit, cleaning the water container is essential for several reasons. First, the container can build a mineral from a local water supply that can eventually become part of the inhaled air. Secondly, the container may eventually show signs of "sluge" coming from dust and other particles that make their way through the air filter that must also be changed for piling up the dirt. To help clean the unit, some patients have used a small amount of hydrogen peroxide mixed with water in a container. They will then let it stand for a few minutes before emptying and rinsing it. If this procedure is used, it is very important to rinse the unit with soap and water before re-installing to the machine and breathing. Anti-bacterial soap is not recommended by the seller. To reduce the risk of contamination, distilled water is a good alternative to tap water. If traveling in areas where mineral content or water purity is unknown or suspected, the alternative is to use a water "purifier" such as Brita. In cold climates, humidified air may require an insulated and/or hot air hose. These can be purchased ready-made, or modified from publicly available materials.
Portability
Because continuous adherence is an important factor in the success of treatment, it is important for travelers to have access to portable equipment. Progressively, PAP units become lighter and more compact, and often come carrying bags. The dual voltage power supply allows many units to be used internationally.
Long distance travel or camping presents special consideration. Most airport security inspectors have seen portable machines, so filtering rarely brings up special problems. Increasingly, the engine is capable of powered by a 400-Hz power supply that is used on most commercial aircraft and includes manual or automatic altitude adjustments. The engine can be easily mounted on a ventilation tray at the bottom or rear of an electric wheelchair with an external battery. Some engines allow power-inverter and/or powering of car batteries.
Some patients with PAP therapy also use supplemental oxygen. When provided in the form of bottled gas, this may lead to an increased risk of fire and subject to restrictions. (Commercial airlines generally prohibit passengers carrying their own oxygen.) Since November 2006, most airlines allow the use of oxygen concentrators.
Availability
In many countries, PAP machines are only available on prescription. A sleep study in an accredited sleep lab is usually required before treatment can begin. This is because the pressure setting on the PAP engine must be tailored to the patient's treatment needs. A sleeping pills doctor, who may also be trained in respiratory medicine, psychiatry, neurology, pediatrics, family practice or otolaryngology (ear, nose and throat), will interpret the results from early sleep studies and recommend stress tests. This can be done overnight (separate studies with diagnostic tests conducted in the first part of the evening, and CPAP testing done in later nights) or by following a second sleep study during CPAP titration may be performed throughout the night. With CPAP titling (split night or all night), patients wear CPAP masks and adjustable pressure up and down from the prescribed settings to find optimal settings. Research has shown that the split-night protocol is an effective protocol for diagnosing OSA and titrating CPAP. The CPAP compliance rate shows no difference between the split-night and two-night protocols.
- In the United States, PAP machines are often available at great discounts online, but a patient who purchases PAP personally has to handle the responsibility for obtaining a replacement from his insurance or Medicare. Many internet providers dealing with insurance such as Medicare will provide upgraded equipment to the patient even if he is only eligible for a basic PAP. In some locations, government programs, separate from Medicare, may be used to claim reimbursement for all or part of the cost of a PAP device.
- In the UK, PAP machines are available under the prescription of the National Health Service after the diagnosis of sleep apnea or privately from the internet by prescribing.
- In Australia, PAP machines can be purchased from the Internet or physical stores. There is no requirement for a prescription, but many suppliers will need referrals. Low-income residents with Commonwealth Health Cards should ask their state's health department about programs that provide free or low-cost PAP machines. Those with private health insurance may be entitled to a partial discount on the cost of CPAP machines and masks. Superannuation can be issued for the purchase of important medical equipment such as PAP machines, on the supply of letters from two doctors, one of which must be a specialist, and an application for the Australian Prudential Regulation Authority (APRA).
- In Canada, CPAP units are widely available in all provinces. Funding for therapy varies from one province to another. In the province of Ontario, the Ministry of Health and the Long Term Care Assistance Program will fund a portion of the CPAP unit costs based on sleep studies in approved sleep labs showing Obstructive Sleep Apnea Syndrome and the signature of a physician approval on the application form. This funding is available to all Ontario residents with a valid health card.
References
Source of the article : Wikipedia
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